85 minutes; standard DVD format (NTSC, SD); chapter menu.
Includes accompanying CD-ROM with handouts in PDF format, slides in PPS format, resource links.
Provider taxonomy – a code that describes a type of healthcare facility or practitioner’s specialty or subspecialty – has taken on new significance with the National Provider Identifier (NPI).
In 2008, Healthcare IT Transition Group conducted a study of the NPI implementation, based on data from the National Provider Identifier Contingency Status Survey. The survey collected data from providers, billers, payers and clearinghouses, representing tens of millions of monthly claims. Among healthcare providers and billers, 44.1% indicated they were encountering difficulty meeting payer requirements for their own taxonomy or taxonomies, and nearly a third said the same for the individual practitioner fields, such as Referring Provider. As of 2009, providers and billing services still report crosswalk problems.
A large percentage of Health Plans indicate that they are using Taxonomy as a component of their matching logic. 50% said they looked at taxonomy code for individual providers and nearly 60% said they took billing provider’s taxonomy into consideration.
But Taxonomy isn't just for getting paid, it's for getting paid more. Understanding the taxonomy system helps providers and billers maximize revenues by using the right code for the right claim and the right payer.
For payers accustomed to assigning proprietary identifiers to their providers, taxonomy is seen as a possible “tie breaker” for reconciling one-to-many NPI matching problems. For providers attempting to balance the conflicting needs of multiple payers’ contracts and billing requirements, taxonomy can help them build claims strategy that reduces days in A/R, and takes advantage of payer contract specificity.
Reports from the field suggest that a large number of providers and their billers aren't using Taxonomy to their advantage.
Video Presentation
- Background on Provider Taxonomy: Theory and practice
- The ultimate situational data element
- Taxonomy with respect to NPI
- Which payers have added Taxonomy requirements to their companion guides?
- Questionable assumptions: Internal designs and external realities
- Medicare’s new taxonomy requirements
- Alternatives to taxonomy
- Recommendations: Taxonomy and trading partners
Documents and Tools on CD-ROM
- Taxonomy requirements by payer, and cross reference by claim type (837I, 837D, etc.) and provider loop (billing provider, rendering provider, etc.)
- Pattern-matching worksheet: color coded breakdowns of the taxonomy hierarchy
- Authoritative links to provider taxonomy resources
- Vendor Taxonomy Capabilities Questionnaire
- Handouts and presentation slides with live resource links
Intended Audience
- Provider personnel: Billing department executives, EDI management personnel, payer relations and contract management personnel.
- Health plan and government payer personnel: Project management, EDI management, provider relations, managed care and contract management personnel.
- Provider billing, payer claims adjudication, clearinghouse and EDI middleware software vendors and RHIO/HIE personnel: Applications development, client services and marketing personnel.
- Persons with responsibility for making provider taxonomy work in healthcare administrative transaction exchanges.
- Persons involved with projects that anticipate using National Plan & Provider Enumeration System (NPPES) data.
